The Doctor’s Office Standoff: How to Disagree Effectively

PJ Hamel Health Guide
  • Osteoporosis is the overriding health concern of many of you reading this. But for me, bone loss is a secondary condition brought on by my #1 challenge, breast cancer. And the intersection of osteopenia with cancer has inspired some rather uncomfortable situations in the doctor’s office.

    Plain and simple, my oncologist wants to save my life; his focus isn’t (nor should it be) on the bone damage done by the cancer drugs I took for 9 long years. Still, I hope to be using this body for a good many years to come; I want to keep it not only free from cancer, but as strong as possible.

    So I took it seriously when a DEXA scan several years ago showed my T-scores plummeting at an alarming rate. At that point, I had no clue that the cancer drug I was taking might be affecting my bones; my oncologist hadn’t mentioned this particular side effect, and I hadn’t bothered to read all the tiny print that came with my plastic bottle of Arimidex.

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    But some online research revealed that yes, a side effect of Arimidex can be bone loss. So I began to “bone up” on osteoporosis. And quickly found myself immersed in a sea of questions.

    T-scores: how low is too low?

    Exercise: what kind, and how much?

    Drugs: bisphos…. Huh?

    I was experiencing osteopenia, but rather than jump right to drugs, I decided to try lifestyle changes first – even though my “bone doctor,” a cancer doc specializing in bone loss, told me I was already “a poster child for a healthy lifestyle.”

    I upped my vitamin D, and tracked my daily calcium carefully, taking extra in liquid form to ensure I was getting enough. I read up on exercise, discovering that the best type is weight-bearing, combined with something that “jars” your bones; walking turned into weightlifting and a more strenuous daily workout.

    A year later, a DEXA scan showed my T-scores had continued to drop. The bone doc suggested a bisphosphonate. I took that information to my oncologist (because when you have cancer, EVERYTHING gets run past your oncologist).

    Surprisingly, he seemed skeptical. “Don’t worry about it,” was his advice.

    In retrospect, he was probably right. Current medical thinking holds that osteopenia is a condition that might qualify as “letting Nature take its course.” Just as we don’t think twice about age spots on our hands or sagging jowls, maybe we should accept thinner bones as a natural part of aging.

    But back then, I was gung-ho to get this osteopenia “cured.” And convinced drugs were the answer.

    I insisted my oncologist prescribe something. “OK, Fosamax,” he said.

    Oh, no… I’d done a bit of research, and knew Merck, Fosamax’s manufacturer, was involved in a class-action lawsuit involving 600+ women claiming Fosamax had given them serious jaw issues. I wanted to avoid Fosamax.

    “How about Actonel?” I countered.

    Dr. S. looked at me in surprise. How does she know anything about osteoporosis drugs, I could hear him wondering. (I think many doctors are surprised at the level of knowledge their patients bring to the table these days, thanks to online research.)

  • “I’d prescribe Fosamax,” he insisted.

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    “But Actonel works faster on more parts of your skeleton,” I said.

    I could see him getting annoyed. How dare I question him? Don’t get me wrong, I love Dr. S; after all, he saved my life. But for the first time in our long relationship, I was doubting his advice; defying him.

    And he didn’t like it.

    Frankly, neither did I. As women, we value relationships above all. And I’ll be seeing Dr. S. for the rest of my years, however many there are; the last thing I want to do is jeopardize our bond. But I REALLY wanted to take Actonel, not Fosamax.

    So I thought fast, and this is what I said: “Dr. S., I value your opinion above all else when it comes to my cancer. But this osteopenia isn’t a life-threatening situation; and it would really help my self-esteem to decide my own course of treatment, and have you trust me enough to accept my decision.”

    I felt so brave! I’m not used to standing up to doctors. Would he be mad? Argue? Tell me I was being foolish?

    Thankfully, he relaxed, and a smile played across his face. I could see him mentally throwing up his hands. “Hey, whatever, your decision,” he said. He wrote a prescription for Actonel, handed it to me, and we parted friends – as always.

    Have you and your doctor disagreed about treatment? Have you chosen to eat healthy and exercise more, rather than take the Fosamax your doctor prescribed? How did the conversation go? Did you feel validated… or brushed off?

    Next time you disagree with your doctor and need to take a stand, be prepared: with information (why you believe in your choice); patience (s/he may want to argue and impose authority), and respect.

    You’re both adults, and both interested in best outcomes. It may simply be that your doc’s idea of a successful outcome (stronger bones) isn’t yours (less healthy bones, but freedom from gastric distress).

    Agree to disagree agreeably, and both of you will walk away satisfied.

Published On: August 09, 2010